Can we safely use betablockers in COPD?

Patients with GOLD classification E of chronic obstructive pulmonary disease (COPD) did not benefit from bisoprolol when compared with a placebo in terms of exacerbation risk. On the bright side, bisoprolol did not raise safety concerns in this population, as was seen in a previous study evaluating a betablocker in a population of patients with COPD.

The BLOCK study, that tested the betablocker metoprolol in 532 patients with severe COPD, was stopped prematurely because of futility and safety concerns [1],” said Dr Bryan Lipworth (University of Dundee, UK). “There was a 2-fold increase in hospitalisation for severe or very severe exacerbations with the betablocker in this population. So, perhaps betablockers aren’t as safe as we thought they were in the COPD population.” The current BICS study assessed the more selective betablocker bisoprolol in patients with GOLD E COPD [2]. Included patients (n=515) were randomised 1:1 to receive either bisoprolol (1.25mg-5mg, determined by dose titration) or placebo for 12 months. Dr Lipworth added that approximately 75% of the patients were on triplet therapy.

The adjusted incidence rate ratio (IRR) was 0.97 (95% CI 0.84-1.13; P=0.72), displaying no difference between the study arms with respect to the occurrence of moderate to severe exacerbations. “We also saw no difference regarding ‘time to first exacerbations’ between the active and placebo arm,” said Dr Lipworth. In contrast to the BLOCK study, this study did not show an increase of very severe COPD exacerbations in the active arm as compared to the placebo arm (adjusted IRR 1.00; 95% CI 0.67-1.50; P=0.99). Finally, there was no substantial effect on quality of life with bisoprolol therapy.

“Comparing BLOCK vs BICS, the annualised exacerbation rate was higher in the BICS population (3.5% vs 1.9%), whereas the patients in BLOCK had more severe disease, which was reflected by the use of long-term oxygen therapy (5% vs 40%),” commented Dr Lipworth. “In general, the fact that bisoprolol is more selective than metoprolol is likely to be the most important contributor to not observing the safety issue in BICS that we did see in BLOCK.”

1. Dransfield MT, et al. NEJM. 2019;381:2304-2314
2. Lipworth BJ, et al. Bisoprolol in COPD study (BICS): a UK randomized controlled trial of bisoprolol in people with COPD at risk of exacerbation. New clinical trial results in chronic lung disease

Medical writing support was provided by Robert van den Heuvel.

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Posted on 11 June 202411 June 2024